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e or Black Ink <br />CT SITE ADDRESS: <br />� PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 j(E) everetteps@everettwa.gov � vwvw.everettwa.gov/permits <br />Piease) PROJECT SITE INFORMATION <br />���� 1��� � l^ � �� �lJr�� PROPERTY TAX #: <br />for new construction: Short PlaUsubdivision <br />No. (attach copy of long legal description) <br />1 BUILDING PERMIT APPLICATION 1 <br />Use of Buildi <br />>sed Use of Buildin : � �t <br />ng Type: ❑SFR-Detached <br />of Project: ❑New ❑Additio <br />:RIPTION OF WORK: � <br />(� �c�('V� Cc�. <br />❑SFR- ttached ❑DuE <br />n ❑Remodel ❑Repai <br />�ASSOCIATED BUILDING PERMIT # (if applicable): <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />❑Multi-Family-# of Units: <br />❑T.I. ❑Siqn ❑Sprinkler <br />I �'�'�1�� i'V�,.Q,�+'1� <br />�Electric <br />❑Demolition <br />❑Other <br />�mmercial ❑Industrial <br />❑Chanqe of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fi tu es Lisi of Fixtures Fixtu es List of Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain �" <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: I have reviewed this application and confirrn the information contained herein is true and correct. Work done pursuant to this permit musf comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building O�cial6efore being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to per/orm the work for which application is made, <br />and I comply with the State Coniracfors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # / y� � � <br />U <br />(Revised 5/20/20i6) <br />\�� <br />